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Referrals audit – district hospitals (referral makers)

Instructions:

  • Complete a separate form entry for each referral made.
  • We suggest completing the audit entry as soon as possible after making the referral.
  • Please do not include any confidential information in your audit entries (e.g.: identifiable details of patients or other clinicians).
District hospital referrals audit (makers)
Time of call
Grade of doctor receiving referral at tertiary hospital?
How was the discussion made?
Name of doctor receiving referral given?
Purpose of call? (tick all that apply)
How well did they understand the purpose of your call?
How helpful was the advice given?
What was the outcome of the call? (tick all that apply)
Was the purpose of your call achieved?
What was your overall impression of the quality of the communication?